The "Difficult" Patient

MBombardier · Post by **MBombardier** » Tue Jan 04, 2011 7:31 pm

Got this from a thyroid e-mail...

The Women's Health 2011: 19th Annual Congress, is taking place April 1-3, 2011. The event is the annual meeting of the American Medical Women's Association (AMWA), which is the key medical organization for "women's medicine," and features dozens of sessions. None of the sessions addresses autoimmune diseases either singularly or as a category.

However, there's a session on Sunday April 3, at 11:40 a.m. with Robert C. Smith, MD, MS, titled "The Difficult Patient: Disordered or Just Different?" And what is a "difficult patient" you might ask? An article Dr. Smith co-authored http://www.uptodate.com/patients/conten ... 5YwpeIWwMb quotes one definition as: "a person who does not assume the patient role expected by the healthcare professional, who may have beliefs and values or other personal characteristics that differ from those of the care-giver, and who causes the caregiver to experience self-doubt." (So, basically, if you dare to disagree with a doctor, then you're "difficult.")

Joefnh · Post by **Joefnh** » Tue Jan 04, 2011 7:36 pm

Sounds to me if you have half a brain and ask questions at you appointments, then you are a difficult patient. By that definition, my doc must think I'm impossible...

--Joe

klhale · Post by **klhale** » Tue Jan 04, 2011 7:42 pm

well if Docs buy into that, they are going to have a real difficult time given the amount of information that is available 24/7 to patients that are seeking a cure.

Post by **Rosie** » Tue Jan 04, 2011 8:00 pm

I haven't been posting much, but this topic caught my attention. I looked at the link, and a couple of things grabbed my attention.

1. Did anyone else notice that the entire burden for being a "difficult patient" is put on the patient? Nowhere is there mention that a doctor's way of interacting with the patient might have any influence. Why don't they also do a study where doctor's who report higher percentages of "difficult" patients than the average are studied to see what traits they have in common that piss off their patients?

2. Did you see where a "difficult" patient has certain characteristics, one of which is "somatoform disorder". Here is the definition.....sound familiar? I guess if the doctor can't find the source of the problem, it's because the patient has a mental disorder!

In people who have a somatoform disorder, medical test results are either normal or don't explain the person's symptoms. Patients with this disorder often become worried about their health because the doctors are unable to find a cause for their health problems. Symptoms are sometimes similar to those of other illnesses and may last for several years.

Rosie

Post by **tex** » Tue Jan 04, 2011 8:46 pm

Rosie wrote:1. Did anyone else notice that the entire burden for being a "difficult patient" is put on the patient? Nowhere is there mention that a doctor's way of interacting with the patient might have any influence.

Yep, I certainly noticed that. Evidently, accusations that many doctors have a deity complex are quite accurate - that certainly applies to the authors of that article, since they never considered the possibility that a doctor's diagnostic procedures may be inadequate in some situations, (for certain diseases of which they are ignorant, for example). Patients are generally considered to be "difficult", when they don't respond to treatment, also, and that is usually the doctor's fault, not a fault of the patient. IOW, doctors tend to misinterpret their inadequate treatment results as due to a "difficult" patient, (so they blame the patient). That's obviously a direct result of a deity complex.

Tex

Celie · Post by **Celie** » Tue Jan 04, 2011 9:06 pm

How enlightening. There are good docs and bad ones. My GI doc encourages my questions and discusses my care with me. I suspect that the good docs have fewer difficult patients.

Celie

Post by **tex** » Tue Jan 04, 2011 9:30 pm

Ceile wrote:I suspect that the good docs have fewer difficult patients.

I'll bet you're right on the money with that observation.

Tex

harvest_table · Post by **harvest_table** » Tue Jan 04, 2011 9:34 pm

Did you see where a "difficult" patient has certain characteristics, one of which is "somatoform disorder". Here is the definition.....sound familiar? I guess if the doctor can't find the source of the problem, it's because the patient has a mental disorder!

There are so many health issues our medical community have labeled as somatization diseases and it's just so wrong to blame the patient.

Our conversations here have been enlightening regarding mast cells and thank you for keeping this issue front and center.

This is a blog I follow which is also posted on this forum in "links to good sites".

http://painmuse.org/?p=369 There is a fibro survey also.

Happy New Year from Fergus Falls!

Joanna

grannyh · Post by **grannyh** » Tue Jan 04, 2011 10:13 pm

Very interesting post. When we lived in Southeast Asia I ran into the "god complex" medical folks.. and most were trained in England. Over time we found doctors who had at least some of their training in the US.. and were more likely to let the American patients interact about treatment.

The doctors who had training in the US (this was over 20 years ago) said that those who only had training in England.. were trained for the Universal type health care there.. where the government controlled the treatment and the patient had no input. This is the kind of medicine coming to the US now...sigh
grannyh

Post by **tex** » Tue Jan 04, 2011 11:26 pm

Joanna,

Thanks for that insight into mast cell disorders.

Love,
Tex

MaggieRedwings · Post by **MaggieRedwings** » Wed Jan 05, 2011 5:59 am

Well I think that article just proves what some of us have known all along. My doctor (PCP), like Joe's, must think I am the most difficult she has met to date. Sometimes, I think she just wishes I would go away. I am doing one more appointment with her in April or May and then looking for a new doctor.

Thanks for posting the article.

Love, Maggie

Robbie · Post by **Robbie** » Wed Jan 05, 2011 8:43 pm

In addition to LC, I have Fibromyalgia (along with a bunch of other stuff, like arthritis, hypothyroid, etc.). My doctor has said "You're hard!" to me more than once. She's not being harsh - she's super open and up front, from what I can tell (I've only been seeing her since June). I collect my records as I go (have an almost complete file on myself) and her chart notes are very favorable towards me. So, while I don't think she is the most qualified doctor in the world, her openness and willingness to try very hard to help me is the main reason I stick with her (that and being in the middle of nowhere, with few options). I have been to more than one doctor (four, I believe) that let me know right up front that most doctors think Fibromyalgia is not real. I believe that it's their way of letting me know they don't think it's real without actually saying it to my face. If a doctor tells me that I never see that doctor again.

There are also those that brush off almost everything I say. Like the time I asked for migraine medicine 12 years ago. I had never tried any, but wanted to. I explained to her that I always carried Tylenol #3 in case I felt one coming on, but that I had heard of migraine meds and wanted to try something that might be more beneficial. She literally yelled at me and said "Tylenol #3 does nothing for migraines - you don't have migraines. I HAVE MIGRAINES! I study migraines and have for years! If you had migraines Tylenol #3 would not touch it!!" I was in shock. Fortunately she moved so I did not have to fire her first. The doctor I went to next put me on Imitrex which helped dramatically, and certainly much better than Tylenol #3.

Oh, the stories I could tell. I tried to get established with another local primary care doctor last March. One of my main complaints was the constant headaches I get in the winter caused by weather inversions. When I told him about it he said "Well, aren't you glad we had such a mild winter and didn't have as many this year", and went on to something else. When I expressed to him that the Fibromyalgia pain (this was before the arthritis diagnosis) was off the chart he pushed himself away from the desk and said "Well, we're all in pain", and that was the end of that. He did insist I take a depression test and get on antidepressants. This in spite of me telling him I had tried quite a few years ago and not only do they not help, they all made me feel worse and caused depression. Needless to say, I did not go back, and it actually delayed my getting treatment for LC because I could not figure out where to go (I have a great doctor in another town, but I was too sick to go out of town).

So, here I sit, after reading the blog about mast cells issues and Fibromyalgia, thinking about how hard I tried to get a mast cell stain (that I feel should have been done in the first place) since Tex and others here suggested it when I joined this forum and told my story last summer. I tried to get the pathologist to do it and could not make that happen, since the wacky pathologist said it was not needed so the insurance company would not pay for it. They would have - I had already checked on that. Because of that incident my doctor suggested I get the big city GI doctor to order for me, since I was going to him anyway. He refused - said it was not called for.

Uggg!!!

Sorry to ramble.........thanks for posting the info......

Gloria · Post by **Gloria** » Wed Jan 05, 2011 10:05 pm

Robbie,

I'm sorry you've had such unfortunate experiences with your doctors. It sounds like the present one, in combination with this board's suggestions is your best bet for now.

Gloria

Post by **tex** » Wed Jan 05, 2011 11:02 pm

Robbie,

FWIW, that doctor who yelled at you about the Tylenol was ignorant. I used to get terrible migraines when I was in a flare - the type that lead to nausea and vomiting after a while, and pretty much force you to stay in a dark room, and stay in bed, but no matter what position you lay in, you can't get comfortable. I found that I could control mine with plain old Tylenol, if I took two of the maximum strength capsules, IF I took it early enough, and IF I took it with food. Otherwise, the Tylenol was worthless, and I was doomed to let the migraine run it's course.

Sorry that you've run into so many jerks disguised as doctors.

Tex

grannyh · Post by **grannyh** » Thu Jan 06, 2011 6:59 am

I used to take tylenol 3 and phenargan for migraines and it worked. Haven't had those headaches in years.. thank heavens. Never had a doctor who said my combination wouldn't work. My current family doc used to give me 30 pills of each a year.. I would take the unused ones in when they expired and threw them away and he gave me new prescriptions.
grannyh